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Adverse effects include addiction , memory problems, paranoia , difficulty sleeping , teeth grinding , blurred vision , sweating , and a rapid heartbeat. MDMA is illegal in most countries \\\\\\\\\\\\\[14\\\\\\\\\\\\\] \\\\\\\\\\\\\[17\\\\\\\\\\\\\] and, as of , has no approved medical uses. MDMA was first made in In general, MDMA users report feeling the onset of subjective effects within 30—60 minutes of MDMA consumption and reaching the peak effect at 75— minutes, which then plateaus for about 3. The experience elicited by MDMA depends on the dose, setting, and user. For example, MDMA used at parties is associated with high motor activity, reduced sense of self-identity as well as poor awareness of the background surroundings. Use of MDMA individually or in a small groups in a quiet environment and when concentrating, is associated with increased lucidity, capability of concentration, sensitivity of aesthetic aspects of the background and emotions, as well as greater capability of communication with others. Sometimes MDMA is labelled as an 'empathogenic' drug, because of its empathy-producing effects. MDMA is often considered the drug of choice within the rave culture and is also used at clubs, festivals and house parties. The psychedelic amphetamine quality of MDMA offers multiple reasons for its appeal to users in the rave setting. MDMA is sometimes taken in conjunction with other psychoactive drugs such as LSD , psilocybin mushrooms , and ketamine , an act called 'candy-flipping'. As of \\\\\\\\\\\\\[update\\\\\\\\\\\\\] , MDMA has no accepted medical indications. Small doses of MDMA are used as an entheogen to enhance prayer or meditation by some religious practitioners. MDMA has become widely known as ecstasy shortened 'E', 'X', or 'XTC' , usually referring to its tablet form, although this term may also include the presence of possible adulterants or dilutants. In part due to the global supply shortage of sassafras oil , substances that are sold as molly frequently contain no MDMA and instead contain methylone , ethylone , MDPV , mephedrone , or any other of the group of compounds commonly known as bath salts. MDMA is usually consumed by mouth. It is also sometimes snorted. Acute adverse effects are usually the result of high or multiple doses, although single dose toxicity can occur in susceptible individuals. The adverse effects that last up to a week following cessation of moderate MDMA use include: As of \\\\\\\\\\\\\[update\\\\\\\\\\\\\] , the long-term effects of MDMA on human brain structure and function have not been fully determined. It is therefore likely that no serotonergic neurotoxicity is present in most casual users. Impairments in multiple aspects of cognition, including attention, learning, memory, visual processing, and sleep have been found in regular MDMA users. Serotonin depletion following MDMA use can cause depression in subsequent days. In some cases depressive symptoms persist for longer. At high doses, MDMA induces a neuroimmune response which, through several mechanisms, increases the permeability of the blood-brain barrier , thereby making the brain more susceptible to environmental toxins and pathogens. MDMA is a moderately teratogenic drug i. Motor delays may be temporary during infancy or long-term. The severity of these developmental delays increases with heavier MDMA use. There are currently no medications to treat MDMA addiction. Rankings for each drug were based on the risk for acute physical harm, the propensity for physical and psychological dependency on the drug, and the negative familial and societal impacts of the drug. The authors did not evaluate or rate the negative impact of ecstasy on the cognitive health of ecstasy users e. MDMA overdose symptoms vary widely due to the involvement of multiple organ systems. Some of the more overt overdose symptoms are listed in the table below. The number of instances of fatal MDMA intoxication is low relative to its usage rates. In most fatalities MDMA was not the only drug involved. Acute toxicity is mainly caused by serotonin syndrome and sympathomimetic effects. A number of drug interactions can occur between MDMA and other drugs, including serotonergic drugs. MDMA acts primarily as a presynaptic releasing agent of serotonin , norepinephrine , and dopamine , which arises from its activity at trace amine-associated receptor 1 TAAR1 and vesicular monoamine transporter 2 VMAT2. Inhibition of VMAT2 by MDMA results in increased concentrations of the associated neurotransmitter serotonin, norepinephrine, or dopamine in the cytosol of a monoamine neuron. In summary, MDMA enters monoamine neurons by acting as a monoamine transporter substrate. MDMA is a ligand at both sigma receptor subtypes, though its efficacies at the receptors have not yet been elucidated. MDMA reaches maximal concentrations in the blood stream between 1. The contributions of these metabolites to the psychoactive and toxic effects of MDMA are an area of active research. MDMA is known to be metabolized by two main metabolic pathways: It is thought that this can result in sustained and higher concentrations of MDMA if the user takes consecutive doses of the drug. MDMA and metabolites are primarily excreted as conjugates, such as sulfates and glucuronides. However, the two enantiomers have been shown to exhibit different kinetics. The disposition of MDMA may also be stereoselective, with the S-enantiomer having a shorter elimination half-life and greater excretion than the R-enantiomer. MDMA is in the substituted methylenedioxyphenethylamine and substituted amphetamine classes of chemicals. As a free base , MDMA is a colorless oil insoluble in water. There are numerous methods available to synthesize MDMA via different intermediates. MDP2P in turn is generally synthesized from piperonal , safrole or isosafrole. Another method uses the Wacker process to oxidize safrole directly to the MDP2P intermediate with a palladium catalyst. MDMA and MDA may be quantitated in blood, plasma or urine to monitor for use, confirm a diagnosis of poisoning or assist in the forensic investigation of a traffic or other criminal violation or a sudden death. Some drug abuse screening programs rely on hair, saliva, or sweat as specimens. Most commercial amphetamine immunoassay screening tests cross-react significantly with MDMA or its major metabolites, but chromatographic techniques can easily distinguish and separately measure each of these substances. At the time, Merck was interested in developing substances that stopped abnormal bleeding. Merck wanted to avoid an existing patent held by Bayer for one such compound: MDMA called methylsafrylamin, safrylmethylamin or N-Methyl-a-Methylhomopiperonylamin in Merck laboratory reports was an intermediate compound in the synthesis of methylhydrastinine. Merck was not interested in MDMA itself at the time. Merck records indicate its researchers returned to the compound sporadically. Compared to ephedrine, Oberlin observed that it had similar effects on vascular smooth muscle tissue, stronger effects at the uterus, and no 'local effect at the eye'. MDMA was also found to have effects on blood sugar levels comparable to high doses of ephedrine. Oberlin concluded that the effects of MDMA were not limited to the sympathetic nervous system. Research was stopped 'particularly due to a strong price increase of safrylmethylamine', which was still used as an intermediate in methylhydrastinine synthesis. Albert van Schoor performed simple toxicological tests with the drug in , most likely while researching new stimulants or circulatory medications. After pharmacological studies, research on MDMA was not continued. In and , the United States Army commissioned a study of toxicity and behavioral effects in animals injected with mescaline and several analogues, including MDMA. Conducted at the University of Michigan in Ann Arbor , these investigations were declassified in October and published in American chemist and psychopharmacologist Alexander Shulgin reported he synthesized MDMA in while researching methylenedioxy compounds at Dow Chemical Company , but did not test the psychoactivity of the compound at this time. This individual later provided these instructions to a client in the Midwest. Shulgin first heard of the psychoactive effects of N-methylated MDA around from a young student who reported 'amphetamine-like content'. They described MDMA as inducing 'an easily controlled altered state of consciousness with emotional and sensual overtones' comparable 'to marijuana, to psilocybin devoid of the hallucinatory component, or to low levels of MDA'. When he tried the drug in , Zeff was impressed with the effects of MDMA and came out of his semi-retirement to promote its use in therapy. Over the following years, Zeff traveled around the United States and occasionally to Europe, eventually training an estimated four thousand psychotherapists in the therapeutic use of MDMA. Psychotherapists who used MDMA believed the drug eliminated the typical fear response and increased communication. Sessions were usually held in the home of the patient or the therapist. The role therapist was minimized in favor of patient self-discovery accompanied by MDMA induced feelings of empathy. Depression, substance abuse, relationship problems, premenstrual syndrome, and autism were among several psychiatric disorders MDMA assisted therapy was reported to treat. Anecdotally, MDMA was said to greatly accelerate therapy. Only later was the term 'ecstasy' used for it, coinciding with rising opposition to its use. In the late s and early s, 'Adam' spread through personal networks of psychotherapists, psychiatrists, users of psychedelics, and yuppies. A small recreational market for MDMA developed by the late s, \\\\\\\\\\\\\[\\\\\\\\\\\\\] consuming perhaps 10, doses in Having commenced production in , this 'Boston Group' did not keep up with growing demand and shortages frequently occurred. Perceiving a business opportunity, Michael Clegg, the Southwest distributor for the Boston Group, started his own 'Texas Group' backed financially by Texas friends. Recreational use also increased after several cocaine dealers switched to distributing MDMA following experiences with the drug. In the next month, the World Health Organization identified MDMA as the only substance out of twenty phenethylamines to be seized a significant number of times. Sensational media attention was given to the proposed criminalization and the reaction of MDMA proponents, effectively advertising the drug. The agency cited increased distribution in Texas, escalating street use, and new evidence of MDA an analog of MDMA neurotoxicity as reasons for the emergency measure. Lawn overruled and classified the drug as Schedule I. While engaged in scheduling debates in the United States, the DEA also pushed for international scheduling. The committee made this recommendation on the basis of the pharmacological similarity of MDMA to previously scheduled drugs, reports of illicit trafficking in Canada, drug seizures in the United States, and lack of well-defined therapeutic use. While intrigued by reports of psychotherapeutic uses for the drug, the committee viewed the studies as lacking appropriate methodological design and encouraged further research. Committee chairman Paul Grof dissented, believing international control was not warranted at the time and a recommendation should await further therapeutic data. The use of MDMA in Texas clubs declined rapidly after criminalization, although by the drug remained popular among young middle-class whites and in nightclubs. Since the mids, MDMA has become the most widely used amphetamine-type drug by college students and teenagers. After MDMA was criminalized, most medical use stopped, although some therapists continued to prescribe the drug illegally. This may be due to increased seizures during use and decreased production of the precursor chemicals used to manufacture MDMA. Unwitting substitution with other drugs, such as mephedrone and methamphetamine , \\\\\\\\\\\\\[\\\\\\\\\\\\\] as well as legal alternatives to MDMA, such as BZP , MDPV , and methylone , are also thought to have contributed to its decrease in popularity. In it was found that some pills being sold as MDMA contained pentylone , which can cause very unpleasant agitation and paranoia. According to David Nutt , when safrole was restricted by the United Nations in order to reduce the supply of MDMA, producers in China began using anethole instead, but this gives para-methoxyamphetamine PMA, also known as 'Dr Death' , which is much more toxic than MDMA and can cause overheating, muscle spasms, seizures, unconsciousness, and death. MDMA is legally controlled in most of the world under the UN Convention on Psychotropic Substances and other international agreements, although exceptions exist for research and limited medical use. In general, the unlicensed use, sale or manufacture of MDMA are all criminal offences. In Australia, MDMA was declared an illegal substance in because of its harmful effects and potential for abuse. Any other type of sale, use or manufacture is strictly prohibited by law. Permits for research uses on humans must be approved by a recognized ethics committee on human research. Although MDMA was not named explicitly in this legislation, the order extended the definition of Class A drugs to include various ring-substituted phenethylamines. Some researchers such as David Nutt have criticized the current scheduling of MDMA, which he determines to be a relatively harmless drug. The United States District Court for the Eastern District of Tennessee explained its ruling by noting that 'an individual federal district court judge simply cannot marshal resources akin to those available to the Commission for tackling the manifold issues involved with determining a proper drug equivalency. A number of ecstasy manufacturers brand their pills with a logo, often being the logo of an unrelated corporation. The Multidisciplinary Association for Psychedelic Studies MAPS is funding pilot studies and clinical trials investigating the use of MDMA in psychotherapy to treat posttraumatic stress disorder PTSD , \\\\\\\\\\\\\[43\\\\\\\\\\\\\] social anxiety in autistic adults, \\\\\\\\\\\\\[4\\\\\\\\\\\\\] \\\\\\\\\\\\\[\\\\\\\\\\\\\] \\\\\\\\\\\\\[\\\\\\\\\\\\\] \\\\\\\\\\\\\[\\\\\\\\\\\\\] \\\\\\\\\\\\\[\\\\\\\\\\\\\] and anxiety in terminal illness. The potential for MDMA to be used as a rapid-acting antidepressant has been studied in clinical trials, but as of the evidence on efficacy and safety were insufficient to reach a conclusion. From Wikipedia, the free encyclopedia. Class F Prohibited substances CA: Anlage I Authorized scientific use only NZ: A salt of MDMA typically white with impurities, resulting in a tan discoloration. Dehydration \\\\\\\\\\\\\[10\\\\\\\\\\\\\] \\\\\\\\\\\\\[28\\\\\\\\\\\\\] \\\\\\\\\\\\\[49\\\\\\\\\\\\\] Hyperthermia \\\\\\\\\\\\\[4\\\\\\\\\\\\\] \\\\\\\\\\\\\[10\\\\\\\\\\\\\] \\\\\\\\\\\\\[49\\\\\\\\\\\\\] Bruxism grinding and clenching of the teeth \\\\\\\\\\\\\[4\\\\\\\\\\\\\] \\\\\\\\\\\\\[10\\\\\\\\\\\\\] \\\\\\\\\\\\\[13\\\\\\\\\\\\\] Increased wakefulness or insomnia \\\\\\\\\\\\\[4\\\\\\\\\\\\\] \\\\\\\\\\\\\[28\\\\\\\\\\\\\] Increased perspiration and sweating \\\\\\\\\\\\\[28\\\\\\\\\\\\\] \\\\\\\\\\\\\[49\\\\\\\\\\\\\] Increased heart rate and blood pressure \\\\\\\\\\\\\[4\\\\\\\\\\\\\] \\\\\\\\\\\\\[10\\\\\\\\\\\\\] \\\\\\\\\\\\\[49\\\\\\\\\\\\\] Increased psychomotor activity \\\\\\\\\\\\\[4\\\\\\\\\\\\\] Loss of appetite \\\\\\\\\\\\\[4\\\\\\\\\\\\\] \\\\\\\\\\\\\[12\\\\\\\\\\\\\] Nausea and vomiting \\\\\\\\\\\\\[13\\\\\\\\\\\\\] Diarrhea \\\\\\\\\\\\\[28\\\\\\\\\\\\\] Erectile dysfunction \\\\\\\\\\\\\[4\\\\\\\\\\\\\] \\\\\\\\\\\\\[51\\\\\\\\\\\\\] Visual and auditory hallucinations rarely \\\\\\\\\\\\\[4\\\\\\\\\\\\\] Mydriasis \\\\\\\\\\\\\[4\\\\\\\\\\\\\]. Trismus \\\\\\\\\\\\\[13\\\\\\\\\\\\\] Loss of appetite \\\\\\\\\\\\\[52\\\\\\\\\\\\\] Insomnia \\\\\\\\\\\\\[52\\\\\\\\\\\\\] Tiredness or lethargy \\\\\\\\\\\\\[53\\\\\\\\\\\\\] \\\\\\\\\\\\\[54\\\\\\\\\\\\\]. Anxiety or paranoia \\\\\\\\\\\\\[52\\\\\\\\\\\\\] Depression \\\\\\\\\\\\\[13\\\\\\\\\\\\\] \\\\\\\\\\\\\[52\\\\\\\\\\\\\] Irritability \\\\\\\\\\\\\[52\\\\\\\\\\\\\] Impulsiveness \\\\\\\\\\\\\[52\\\\\\\\\\\\\] Restlessness \\\\\\\\\\\\\[52\\\\\\\\\\\\\] Memory impairment \\\\\\\\\\\\\[13\\\\\\\\\\\\\] Anhedonia \\\\\\\\\\\\\[52\\\\\\\\\\\\\]. MDMA binds to serotonin transporters. MDMA is a racemic mixture and exists as two enantiomers: German patents for MDMA synthesis and the subsequent methylhydrastinine synthesis filed by Merck on 24 December and issued in List of investigational anxiolytics. United States National Library of Medicine. Retrieved 31 August Medical toxicology of drug abuse: Reinforcement and Addictive Disorders'. A Foundation for Clinical Neuroscience 2nd ed. The European Journal of Neuroscience. Current Drug Abuse Reviews. Animal and human studies demonstrate moderate abuse liability for MDMA, and this effect may be of most concern to those treating substance abuse disorders. Retrieved 17 October Drugs and Human Performance Fact Sheets. National Highway Traffic Safety Administration. Archived from the original on 31 May National Institute on Drug Abuse. Archived from the original on 3 December Retrieved 2 December Retrieved 18 June Hazardous Substances Data Bank. National Library of Medicine. Retrieved 22 August Substance Abuse and Rehabilitation. Archived from the original on 23 March Retrieved 30 March A comprehensive review on their mode of action, treatment of abuse and intoxication. Mental and neurological public health a global perspective 1st ed. Archived from the original on 10 September You Probably Have Some Questions'. The New York Times. Retrieved 14 July Retrieved 9 October United States Food and Drug Administration. Archived from the original on 9 October A breakthrough therapy is a drug: Archived from the original on 29 August Retrieved 29 August Neuroscience of Psychoactive Substance Use and Dependence. Archived from the original on 28 April MDMA changes how people talk about significant others'. A comprehensive look at the risks and benefits of MDMA. The Science of Subjective Experience. Controlled studies in humans and laboratory animals'. Neuroscience and Biobehavioral Reviews. Into the World of Techno and Rave Culture. The British Journal of Psychiatry. Innovations in Clinical Neuroscience. MDMA is listed as a Schedule 1 drug by the United States Drug Enforcement Agency, meaning that currently there are no accepted medical uses for MDMA in the United States, there is a lack of accepted safety for use under medical supervision, and there is a high potential for abuse. International Journal of Psychiatry in Medicine. Pharmacology and abuse of cocaine, amphetamines, ecstasy and related designer drugs a comprehensive review on their mode of action, treatment of abuse and intoxication Online-Ausg. Retrieved 22 February Retrieved on 11 June MDMA use as an adjunct to spiritual pursuit'. Journal of Psychoactive Drugs. United States Department of Justice: Retrieved 10 April Journal of Clinical Pharmacology. Retrieved 14 May Drug Abuse and Addiction in Medical Illness: Causes, Consequences and Treatment. Dialogues in Clinical Neuroscience. In contrast, MDMA produces damage to serotonergic, but not dopaminergic axon terminals in the striatum, hippocampus, and prefrontal cortex Battaglia et al. The damage associated with Meth and MDMA has been shown to persist for at least 2 years in rodents, non-human primates and humans Seiden et al. Given the dose-response relationship between MDMA exposure and SERT reductions and the statistically non-significant SERT binding differences for users with use levels similar to the majority of real-life users, it can be speculated that SERT levels may not be significantly affected for most recreational ecstasy users. Human biology 10th ed. British Journal of Pharmacology. Drug and Chemical Toxicology. In summary, MDMA is a moderate teratogen that could influence cardiac and neuronal differentiation in the ESC model and these results are in concordance with previous in vivo and in vitro models. The Journal of Neuroscience. Clinical Textbook of Addictive Disorders. It seems to present a smaller addiction potential than cocaine or methamphetamine. Principles of addiction medicine 4th ed. There are no known pharmacological treatments for MDMA addiction. British Journal of Anaesthesia. It is known that some recreational drugs e. Oxford American Handbook of Critical Care. British Journal of Nursing. Clinical Journal of the American Society of Nephrology. Retrieved 15 May It enters neurons via carriage by the monoamine transporters. Once inside, MDMA inhibits the vesicular monoamine transporter, which results in increased concentrations of serotonin, norepinephrine, and dopamine into the cytoplasm, and induces their release by reversing their respective transporters through a process known as phosphorylation. Therapeutic opportunities and challenges'. The subsequently observed regulatory effect of TAAR1 on dopaminergic systems has further strengthened this interest, given their well-documented involvement in reward circuitry. European Journal of Pharmacology. Expert Review of Clinical Pharmacology. Annals of the New York Academy of Sciences. Journal of Chromatography B. The Journal of Pharmacology and Experimental Therapeutics. A putative structure-toxicity relationship'. Chemical Research in Toxicology. Analytical and Bioanalytical Chemistry. United Nations Office on Drugs and Crime. Retrieved 1 December Retrieved on 12 August Plasma pharmacokinetics of 3,4-methylenedioxymethamphetamine after controlled oral administration to young adults. Merck in Darmstadt 16 May Verfahren zur Darstellung von Alkyloxyaryl-, Dialkyloxyaryl- und Alkylendioxyarylaminopropanen bzw. Retrieved 12 April Merck in Darmstadt 15 October Verfahren zur Darstellung von Hydrastinin Derivaten'. Toxicology and Applied Pharmacology. Acta Polon Pharm in Polish. Nonmedical use and intoxication' PDF. The New York Times Company. Retrieved 27 August Retrieved 4 January Drug Abuse Information and Monitoring Project. Retrieved 6 August Alexander Shulgin Research Institute. Retrieved 8 January A Chemical Love Story 7th printing, 1st ed. In Willette, Robert E. The Psychopharmacology of Hallucinogens. New York Times Magazine. Primetime Thursday Special edition. Archived from the original on 27 May Multidisciplinary Association for Psychedelic Studies. Retrieved 7 January Sage Publications , Inc. Retrieved 10 August A New Drug for a New Millennium'. Retrieved 15 January Retrieved 1 February Retrieved 29 April Food and Drug Administration. Retrieved 11 August Retrieved 7 August Street Abuse Cited; Used by Psychiatrists'. Retrieved 28 August Archived from the original PDF on 19 October Commission on Narcotic Drugs. Retrieved 9 May Retrieved 9 December Retrieved 23 February Why is it called Molly? Pure, but Not So Simple'. Retrieved 24 February Retrieved 31 December Retrieved 14 February World Drug Report Retrieved 7 July The Government of Western Australia. Department of the Premier and Cabinet. Retrieved 4 December Retrieved 3 November Retrieved on 29 August Controlled Drugs and Substances Act. Drug and Alcohol Dependence. Office for Official Publications of the European Communities. Archived from the original on 8 December Retrieved 2 January What have we done and what is there left to do? Archived 9 February at the Wayback Machine. Retrieved 3 March Archived from the original on 12 August A new treatment model for social anxiety in autistic adults'. Retrieved 18 May A Really Good Day: Knopf Doubleday Publishing Group. Archived from the original on 24 April Retrieved 28 April Archived from the original on 6 January Therapeutic Advances in Psychopharmacology. Calea zacatechichi Silene capensis. Coffee break Coffeehouse Latte art Tea house. Abuse Date rape drug Impaired driving Drug harmfulness Effects of cannabis Addiction Dependence Prevention Opioid replacement therapy Rehabilitation Responsible use Drug-related crime Fetal alcohol spectrum disorder Long-term effects of cannabis Neurotoxicity Overdose Passive smoking of tobacco or other substances. Alcohol legality Alcohol consumption Anabolic steroid legality Cannabis legality Annual use Lifetime use Cigarette consumption Cocaine legality Cocaine use Methamphetamine legality Opiates use Psilocybin mushrooms legality Salvia legality. Diphenidine Ephenidine Fluorolintane Methoxphenidine. Dextrallorphan Dextromethorphan Dextrorphan Racemethorphan Racemorphan. Apomorphine Aporphine Bromocriptine Cabergoline Lisuride Memantine Nuciferine Pergolide Phenethylamine Piribedil Pramipexole Ropinirole Rotigotine Salvinorin A Also indirect D 2 agonists, such as dopamine reuptake inhibitors cocaine , methylphenidate , releasing agents amphetamine , methamphetamine , and precursors levodopa. Glaucine Isoaminile Noscapine Pukateine. Adapromine Amantadine Bromantane Memantine Rimantadine. Oxiracetam Phenylpiracetam Phenylpiracetam hydrazide. SoRI Adrenergic release blockers: AR-A Beta blockers e. Agomelatine Atypical antipsychotics e. Adatanserin Agomelatine Atypical antipsychotics e. Alosetron Arazasetron AS Atypical antipsychotics e. ABT Atypical antipsychotics e. Human trace amine-associated receptor ligands. N , N -Dimethylethylamine Trimethylamine. Retrieved from ' https: Views Read View source View history. In other projects Wikimedia Commons. This page was last edited on 16 December , at By using this site, you agree to the Terms of Use and Privacy Policy. Low—moderate \\\\\\\\\\\\\[3\\\\\\\\\\\\\] \\\\\\\\\\\\\[4\\\\\\\\\\\\\] \\\\\\\\\\\\\[5\\\\\\\\\\\\\]. Disseminated intravascular coagulation \\\\\\\\\\\\\[28\\\\\\\\\\\\\] Intracranial hemorrhage \\\\\\\\\\\\\[28\\\\\\\\\\\\\] Severe hypertension \\\\\\\\\\\\\[28\\\\\\\\\\\\\] \\\\\\\\\\\\\[82\\\\\\\\\\\\\] or hypotension \\\\\\\\\\\\\[28\\\\\\\\\\\\\] Hypotensive bleeding \\\\\\\\\\\\\[4\\\\\\\\\\\\\]. Hyperreflexia \\\\\\\\\\\\\[83\\\\\\\\\\\\\] Agitation \\\\\\\\\\\\\[28\\\\\\\\\\\\\] \\\\\\\\\\\\\[82\\\\\\\\\\\\\] Mental confusion \\\\\\\\\\\\\[28\\\\\\\\\\\\\] Paranoia \\\\\\\\\\\\\[28\\\\\\\\\\\\\] \\\\\\\\\\\\\[82\\\\\\\\\\\\\] Stimulant psychosis \\\\\\\\\\\\\[4\\\\\\\\\\\\\] \\\\\\\\\\\\\[10\\\\\\\\\\\\\]. Cognitive and memory impairment \\\\\\\\\\\\\[28\\\\\\\\\\\\\] potentially to the point of retrograde or anterograde amnesia \\\\\\\\\\\\\[84\\\\\\\\\\\\\] Coma \\\\\\\\\\\\\[10\\\\\\\\\\\\\] \\\\\\\\\\\\\[82\\\\\\\\\\\\\] Convulsions \\\\\\\\\\\\\[28\\\\\\\\\\\\\] \\\\\\\\\\\\\[82\\\\\\\\\\\\\] Hallucinations \\\\\\\\\\\\\[28\\\\\\\\\\\\\] \\\\\\\\\\\\\[82\\\\\\\\\\\\\] Loss of consciousness \\\\\\\\\\\\\[10\\\\\\\\\\\\\] Serotonin syndrome \\\\\\\\\\\\\[10\\\\\\\\\\\\\] \\\\\\\\\\\\\[28\\\\\\\\\\\\\] \\\\\\\\\\\\\[50\\\\\\\\\\\\\]. Muscle rigidity \\\\\\\\\\\\\[28\\\\\\\\\\\\\] Rhabdomyolysis i. Acute respiratory distress syndrome \\\\\\\\\\\\\[28\\\\\\\\\\\\\]. Acute kidney injury \\\\\\\\\\\\\[28\\\\\\\\\\\\\] \\\\\\\\\\\\\[85\\\\\\\\\\\\\]. Cerebral edema \\\\\\\\\\\\\[10\\\\\\\\\\\\\] Hepatitis \\\\\\\\\\\\\[28\\\\\\\\\\\\\] \\\\\\\\\\\\\[50\\\\\\\\\\\\\] Hyperpyrexia a life-threatening elevation of body temperature \\\\\\\\\\\\\[28\\\\\\\\\\\\\] \\\\\\\\\\\\\[50\\\\\\\\\\\\\] Hyponatremia Syndrome of inappropriate antidiuretic hormone \\\\\\\\\\\\\[28\\\\\\\\\\\\\] \\\\\\\\\\\\\[49\\\\\\\\\\\\\] \\\\\\\\\\\\\[50\\\\\\\\\\\\\].

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